West Lori J, Karamlou Tara, Dipchand Anne I, Pollock-BarZiv Stacey M, Coles John G, McCrindle Brian W
Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2006 Feb;131(2):455-61. doi: 10.1016/j.jtcvs.2005.09.048.
Recent data suggest that ABO blood group-incompatible donor hearts are immunologically well tolerated in infants undergoing transplantation.
Competing-risks methodology was used to assess outcomes after listing and the impact of a strategy to accept heart grafts from any blood group donor for infants less than 18 months of age.
From 1992 to 2002, there were 91 listing episodes in 84 patients (including 20 fetuses; 50% were male and 63% had congenital heart disease). Beginning in 1995, a strategy to accept ABO-incompatible organs was adopted. Competing-risks analysis showed that after 20 months 60% underwent transplantation, 18% died, and less than 1% were still listed; the remaining 21% were de-listed because of a change of surgical strategy (9%), improved clinical condition (8%), and deterioration to ineligibility (4%). Risk factors for transplantation included only a strategy to accept ABO-incompatible organs (P <.001). Risk factors for death included failure to accept ABO-incompatible organs (P =.002) and Canadian listing status 3 (P =.085) or 4 (P <.001). Multivariable parametric models were used to create competing risk predictions for outcomes specific to status and ABO-incompatible strategy. Higher status resulted in greater mortality regardless of strategy, although for any status, more patients underwent transplantation and fewer died using a strategy to accept ABO-incompatible organs. Parametric modeling of time-related freedom from death or retransplantation demonstrated no significant difference at 4 years posttransplantation (P =.78) for ABO-incompatible (74%) versus ABO-compatible transplants (72%).
A strategy to accept ABO-incompatible donor hearts for infant transplantation significantly improves the likelihood of transplantation and reduces waiting list mortality while not adversely altering outcomes after transplantation.
近期数据表明，在接受移植的婴儿中，ABO血型不相合的供心在免疫方面耐受性良好。
采用竞争风险方法评估登记后的结局，以及接受18个月以下婴儿任何血型供者心脏移植策略的影响。
1992年至2002年，84例患者有91次登记事件（包括20例胎儿；50%为男性，63%患有先天性心脏病）。从1995年开始，采用了接受ABO血型不相合器官的策略。竞争风险分析显示，20个月后，60%的患者接受了移植，18%死亡，不到1%仍在登记；其余21%因手术策略改变（9%）、临床状况改善（8%）和病情恶化不符合条件（4%）而被取消登记。移植的风险因素仅包括接受ABO血型不相合器官的策略（P<.001）。死亡的风险因素包括未接受ABO血型不相合器官（P=.002）以及加拿大登记状态为3（P=.085）或4（P<.001）。使用多变量参数模型对特定状态和ABO血型不相合策略的结局进行竞争风险预测。无论采用何种策略，较高的状态都会导致更高的死亡率，尽管对于任何状态，采用接受ABO血型不相合器官的策略时，接受移植的患者更多，死亡的患者更少。移植后4年，ABO血型不相合移植（74%）与ABO血型相合移植（72%）在无死亡或再次移植的时间相关自由度的参数建模中无显著差异（P=.78）。
接受ABO血型不相合供心进行婴儿移植的策略显著提高了移植的可能性，降低了等待名单上的死亡率，同时不会对移植后的结局产生不利影响。
